A brief presentation on Day Case Surgery

1. Day Case Surgery
Dr. Bhipi Chandra Ray
Resident, Phase A, Urology, Year 02, Block-06
Bangabandhu Sheikh Mujib Medical University
Presenter:

2. Outlines
• Introduction
• Day surgery pathway
• Patient selection criteria
• Preoperative assessment, counselling & scheduling
• Anaesthesia & analgesia
• Advantages, disadvantages & barriers
• Common day cases in paediatric surgery
• Components of an emergency day case surgery
• Discharge criteria

3. History of Day Surgery
• James Henderson Nicoll a 19th century
paediatric surgeon in Glasgow, is the
father of day case surgery
• Has nine thousand day surgeries in his
dispensary
• Believed in inpatient care to be waste of
resources

4. What Is Day Case Surgery?
• The admission of selected patients to hospital for a
planned procedure, returning home on same day
• It extends from first contact to final discharge of a patient
• Success depends on each component of this pathway that
will be safe, efficient & performed in sequence
• Over 200 procedures are now considered to be suitable as
day case

5. Types of Day Surgery
Two types
i. Elective day surgery
ii. Emergency day surgery

6. Forms of Ambulatory Surgery
• Day or same day surgery: admit & discharge in 12 hours
• Procedure room surgery: No full sterile theatre facilities
• Overnight stay: 23 hours admission with early morning
discharge
• Short stay surgery: up to 72 hours
• Outpatient surgery: Not admitted to ward facility
• Inpatient surgery: Requires more prolong admission

7. Referral
Surgical
Assessment
Patient
Selection
Booking
Preoperative
assessment
Admission
Surgery
Discharge
Day surgery
follow-up
MDT F/U if
required
Day Surgery Pathway

8. Patient Selection Criteria
• Low risk of significant immediate postoperative
complications e.g. catastrophic bleeding or
airway compromise
• Patient is able to eat & drink or take oral
nutrition postoperatively
• Modern anesthetic facilities
• Minimal access in abdomen or thorax
Surgical criteria:

9. Continue…
• No arbitrary cuts-off age, weight or criteria
except comorbidities & functional status
• Diabetes: Controlled HbA1C < 8.5%. Return
asap to normal feeding after operation
• Epilepsy: Not contraindicated if controlled
• Obesity: Morbidly obese patients can be
managed safely in expert hands with
appropriate resources
Medical criteria

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• Suitable home environment with a
responsible, mentally & physically
fit care giver
• Drive at a hospital < 1 hour
Social criteria:

11. Preoperative Assessment
It has three essential components:
• To educate patients & carers regarding day surgery pathways
• Well-informed & well-prepared patient
• To identify medical risk factors, promote health & optimize
the patient's condition

12. Patient Counselling Before Day Surgery
Ideally should include
• Proposed operation & its details
• Benefits, risks & complications of operation
• Consequences if operation is not done
• Alternative procedures or medications
• Complications of anaesthesia

13. Scheduling
• Day surgery ideally will be first on list with inpatient cases
• Avoid complex inpatient cases on same day

14. Anaesthesia & Analgesia
• Premedication & a multimodal analgesia approach
• Short-acting general anaesthesia agents, day case spinal
or regional anaesthesia techniques should be used to
enable rapid recovery
• TIVA using propofol offers better result with less PONV
• Avoid long acting opiates, e.g. morphine to reduce
sedation & PON

15. Advantages of Day Case Surgery
For patient:
• Significant reduction of hospital cost
• Better comfort & greater control over patient’s personal life
• Reduces risk of hospital acquired infection
For hospital
• Provide greater patient satisfaction
• Increase availability of inpatient beds

16. Disadvantages of Day Case Surgery
• Timing delay in operation day due to long queue
• Burden of care passed on to family members
• Good organization & management needed
• Morbidity from anesthesia & surgery

17. Barriers to Day Surgery
• Patient’s lack of awareness about benefits
• Long distance from hospital to home
• Inadequate infrastructure for transport
• Long outpatient queues & operation dates

18. Common day cases in Paediatric Surgery
• Ritual circumcision
• Inguinal hernia
• Hydrocele
• Undescended palpable testes
• Dermoid cyst
• Abscess (Axillary, neck, perianal, groin)

19. • Sebaceous cyst
• DJ stent removal
• Tongue tie
• Mucus retention cyst
• Bakers cyst etc
Continue…

20. Discharge Criteria
• Vital signs stable for at least 1 hour
• Correct orientation as to time, place & person if
appropriate
• Adequate pain control with supply of oral analgesia
• Understands how to use oral analgesia that supplied
• Ability to dress & walk where appropriate
• Minimal nausea, vomiting or dizziness

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• Has taken oral fluids
• Minimal bleeding or wound drainage
• Has passed urine
• Has a responsible adult to take home
• Written & verbal instructions given about post
operative care
• Knows when to come back for follow up
• Emergency contact number supplied

22. Components of an Emergency Day Surgery
• Identification of appropriate procedures
• Ensuring clear pathways are in place
• Determining whether the condition is safe to be left
untreated for up to 24 hours & manageable at home with
oral analgesia
• Providing clear preoperative patient information, ideally in
writing

23. Take Home Message
• There is no difference in anaesthesia & surgical techniques
between day case surgery & usual operation
• Less disruption of patient’s domestic & social life
• A cost saving approach for both patient & hospital

25. Thank You